Northwest Regional Hospital, Burnie, Tasmania, Australia.
Seth GS Medical College and King Edward Memorial Hospital, Mumbai, India.
J Matern Fetal Neonatal Med. 2022 Dec;35(25):5478-5488. doi: 10.1080/14767058.2021.1884676. Epub 2021 Feb 10.
To conduct a systematic review and meta-analysis to compare the efficacy and safety of umbilical cord milking (UCM) versus delayed cord clamping (DCC) in term and late-preterm infants.
MEDLINE, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials, Clinical trial registries, and Gray literature were searched for randomized controlled trials (RCTs) comparing UCM with DCC in term and late-preterm infants for both short-term and long-term outcomes. Intact and cut UCM were compared separately with DCC using subgroup analysis. We used fixed effect model to pool the data. Random effects model was used when there was significant heterogeneity.
Nine studies (1632 infants) were included in the systematic review. Milking was performed on intact cord (i-UCM) in five studies ( = 829) and on cut cord (c-UCM) in four studies ( = 803). Cord milking significantly improved hemoglobin level at 48-72 h of life when compared to DCC (six studies, = 924, mean difference 0.36 g/dL; 95% CI: 0.19-0.53). In addition, hemoglobin level at six to eight weeks of age was also significantly higher in the studies comparing i-UCM with DCC (two studies, = 550: mean difference 0.16 g/dL; 95% CI: 0.06-0.27). There was no difference between the UCM group and DCC group for any other outcome. Only one study provided information on growth and hematological parameters at one year of age. Neurodevelopmental outcomes were not reported. None of the studies included non-vigorous infants. The grade of evidence was low to very low for all the outcomes studied.
UCM is comparable to DCC in improving short-term hematological outcomes in term and late-preterm vigorous infants. Trials assessing the effect of UCM on important clinical and long-term outcomes among non-vigorous mature preterm infants are urgently required.
系统评价和荟萃分析比较脐带挤奶（UCM）与延迟脐带结扎（DCC）在足月和晚期早产儿中的疗效和安全性。
检索 MEDLINE、EMBASE、CINAHL、Cochrane 对照试验中心注册库、临床试验注册库和灰色文献，以比较足月和晚期早产儿中 UCM 与 DCC 对短期和长期结局的随机对照试验（RCT）。使用亚组分析分别比较完整脐带 UCM（i-UCM）和切断脐带 UCM（c-UCM）与 DCC 的比较。我们使用固定效应模型汇总数据。当存在显著异质性时，使用随机效应模型。
本系统评价纳入了 9 项研究（1632 名婴儿）。5 项研究（ = 829）进行了完整脐带 UCM，4 项研究（ = 803）进行了切断脐带 UCM。与 DCC 相比，挤奶可显著提高生命 48-72 小时时的血红蛋白水平（6 项研究， = 924，平均差异 0.36 g/dL；95%CI：0.19-0.53）。此外，与 DCC 相比，比较 i-UCM 与 DCC 的研究中，6 至 8 周龄时的血红蛋白水平也显著升高（两项研究， = 550：平均差异 0.16 g/dL；95%CI：0.06-0.27）。UCM 组与 DCC 组在任何其他结局方面均无差异。仅有一项研究提供了 1 岁时生长和血液学参数的信息。神经发育结局未报告。所有研究均未纳入非活力婴儿。所有研究的证据等级均为低至极低。
UCM 在改善足月和晚期早产儿活力婴儿的短期血液学结局方面与 DCC 相当。迫切需要评估 UCM 对非活力成熟早产儿重要临床和长期结局影响的试验。
